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Insurers edge physicians out of the medication process

A March 9 Becker’s Hospital Review article explains why the AHA is sending out an SOS.

This isn’t the first time the American Hospital Association (AHA) has flagged insurance company policies that take decisions regarding patient care away from the physicians they know and trust. Just recently, we covered a story on the AHA flagging UnitedHealthcare’s misguided new policy around specialty drugs. Now, the AHA is raising the issue to policymakers regarding all insurers’ drug policies that, from the looks of it, lock in their own profits and shut out physicians’.

These policies dictate that physicians surrender the responsibility of ordering, storing, and dispensing specialty drugs. Instead, that job goes to pharmacy benefit managers and specialty pharmacies—which are often owned by the insurance companies. Why would insurers want to cut physicians out of the process? One guess. It rhymes with “funny,” but nobody’s laughing. It seems to us that these policies were devised to remove physicians’ oversight of the medication process so that insurers can micromanage costs.

We see serious risks if these policies are left in place. The origin of a drug, and how it’s been stored and handled, determines its quality. If physicians’ oversight of the “chain of custody” for advanced medications is removed, they can no longer guarantee the safety, appropriateness, and timeliness of those drugs. What happens when an insurer pre-orders doses of chemotherapy drug but a patient’s same-day lab results change their dose? Critical treatments for seriously ill patients can be delayed and costly drugs wasted.

We hope that policymakers take heed—and take issue with—policies that put clinical care decisions into the hands of insurers, who have a long history of making choices that are cheaper for their stockholders, rather than healthier for their members who pay their salaries.

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